What is the target blood pressure (BP) in individuals over 80 years old?

From the Guidelines

For individuals over 80 years old, the target blood pressure should be below 130/80 mmHg, as recommended by the 2017 American College of Cardiology/American Heart Association hypertension guideline 1. This target is based on evidence from studies such as HYVET and SPRINT, which showed substantial benefit in reducing cardiovascular risk in older adults with intensive blood pressure treatment 1. However, it is essential to consider individual factors, such as frailty and comorbidity, when determining the target blood pressure, and to initiate treatment gradually and monitor carefully to avoid adverse effects like orthostatic hypotension and falls. Some key points to consider when treating hypertension in older adults include:

• Starting medication doses at the lower end of the range and titrating slowly
• Measuring blood pressure both sitting and standing to detect orthostatic changes
• Using a team-based approach to assess the risk-benefit tradeoffs of treatment in older adults with a high burden of comorbidity and limited life expectancy
• Considering patient preference and clinical judgment when making decisions about the choice of drug and intensity of blood pressure control. The medication regimen typically starts with a thiazide diuretic, a calcium channel blocker, or an ACE inhibitor/ARB, and careful monitoring for adverse effects is essential 1.

From the Research

Blood Pressure Targets for Adults Over 80 Years Old

• The American College of Cardiology (ACC)/American Heart Association (AHA) 2011 expert consensus document recommends a systolic blood pressure target of 140 to 145 mmHg if tolerated in adults aged 80 years and older 2.
• The European Society of Hypertension recommends reducing systolic blood pressure to between 140 mmHg and 150 mmHg in fit individuals older than 80 years with an initial systolic blood pressure of 160 mmHg or higher 3.
• A Cochrane review found that there is insufficient evidence to determine whether a higher blood pressure target (less than 150 to 160/95 to 105 mmHg) or a lower blood pressure target (less than 140/90 mmHg) is better for older adults with high blood pressure 4.
• Another study suggests that a systolic blood pressure target below 130 mmHg can be recommended for hypertensive patients aged 65-80 years, but there is no conclusive evidence to support a stringent blood pressure target for patients aged 80 years and older 5.

Considerations for Blood Pressure Management in Older Adults

• The selection of antihypertensive medications for elderly patients requires consideration of their cardiovascular condition and potential contraindications 5.
• Combination therapy may be necessary to achieve the desired blood pressure target 6, 5.
• Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the primary choices for patients with chronic kidney disease (CKD) 5.
• Newer generation mineralocorticoid receptor antagonists may further reduce the risk of cardiovascular or renal events in this population 5.